Transcript: Dr Hambleton, ABC 720, Perth, 25 October 2011
TRANSCRIPT - ASYLUM SEEKERS, INDIGENOUS HEALTH AND MENTAL HEALTH
GEOFF HUTCHISON: Dr Steve Hambleton was elected the federal president of the AMA in May, and he's come to WA for the first time in this new role, having spent the last couple of days touring the north west, and looking at health conditions of Aboriginal communities in and around Broome.
And I'm sure he's going to have some quite interesting opinions on the rather disturbing revelations on Four Corners last night - the amount of asylum seekers detained suffering severe mental health issues, dozens who have tried to kill themselves, up to 30 at a time on suicide watch - and how medication is being misused.
The Curtin detention facility near Derby was labelled as the worst in Australia. Dr Hambleton joins me in the studio. Very good morning to you.
STEVE HAMBLETON: Good morning.
GEOFF HUTCHISON: First and foremost, how concerned are you about the things that were revealed on Four Corners last night? There has been long suspicion and long concern about the mental health of detainees.
STEVE HAMBLETON: Well look, now we're getting hard and sound evidence on harm to humans and harm to their health. We've said it before that there are rising rates of post traumatic stress disorder, anxiety, depression. Look, we're seeing that in adults, and we're seeing it in children.
And we've even had cases where nine and a half year olds have had serious suicide attempts.
And these health issues are really really disturbing. They're large in number, and they're very remote. We also said it's very hard to get services into those areas because they're so remote. I mean the fact that there's mandatory detention for an indeterminate period - people just don't know where they're going in the future, they don't know what's going to happen, and what outcomes there are going to be.
And we know that some - well, 85 per cent of those people are going to end up Australian citizens. So we're damaging our future Australian citizens, and we're causing problems because of the way we're doing things.
And we've really got to wake up to ourselves.
GEOFF HUTCHISON: There was a lot of concern expressed last night about the manner in which medication was being misused, instead of sleeping pills people were being given anti-depressive medications. And really it seemed that very little attention was given to the efficacy of this medicine and the possible side effects as well.
STEVE HAMBLETON: Look, some of these concerns are really very disturbing, and I guess it's part of the problem of being so remote - having trained people onsite to make those decisions about the best clinical use of medication.
You know, clearly, some of those are being distorted, and people are getting a medication that perhaps isn't ideal for them. And I guess that's part of the fact that health care workers can't be there constantly with them, supervising and looking after people.
GEOFF HUTCHISON: This is pretty consistent with what the AMA has always said, isn't it, that the AMA what, does not want people to be held in detention - or certainly doesn't want families in detention.
STEVE HAMBLETON: Well look, there's a whole lot of things about that. The government's own policy is that people shouldn't be held more than 90 days. Well we've had people who've been in detention for over a year. It's the uncertainty of the future that's part of the problem.
We've got children in detention, there's something like 350 children in detention at the moment, and certainly about 81 of those are unaccompanied. And that sort of, those sort of statistics are really disturbing. And these are kids that, you know, I guess minors, less than 18, with no family around. And they're - and we're trying to look after them.
You know, people in those detention centres are not health care workers, they're not childcare workers, and they're not getting the care they really need.
GEOFF HUTCHISON: So by default we have a situation whereby those seeking asylum who come into Australian waters will be processed on Christmas Island, and now they will move into the community.
That was not the intention of either government or Opposition although there are some who say that's what should always have been the case.
Does the AMA have a view on that?
STEVE HAMBLETON: Look, I think our view really is focused on the health of these people. And we know that putting them in mandatory detention in remote locations is bad for their health. So if we can change that, if we can actually improve the health of these individuals, if we can support them better, we'll get a better outcome in health stakes.
It's important for adults, but it's even more important for children.
GEOFF HUTCHISON: Quarter past nine, you're listening to Dr Steve Hambleton, the new AMA federal president. Tell me a bit about your trip up north. What did you see, and you were seeing it with very fresh eyes.
STEVE HAMBLETON: Well look, there's some good news stories in fact. We went to first Darwin and then on to Broome, and we spent a few days in Broome, the Australian Indigenous Doctors' Association had their national conference up there.
And we were happy to participate in that.
We also saw the Kimberley Aboriginal Medical Services Council which is actually the body that has a bit of a hub and spoke model to oversee Aboriginal services up in the Kimberley area.
And we heard some good news, I mean we heard that they're actually teaching and training the next generation of doctors to work in general practice and in Aboriginal health. And they've actually got more applicants than they've got locations, which is the first time I've ever heard that.
GEOFF HUTCHISON: Yeah.
STEVE HAMBLETON: They've also got improved funding for mental health services in the remote areas, even in Kununurra, but they're, what they're faced with now is actually infrastructure to provide that from.
They haven't got the housing to provide the health workers to do the work.
They've got the health workers without the housing.
We've talked about the social determinants of health before with making sure that Aboriginal people have got appropriate housing in education and sanitation et cetera. But now there's the facilities for the workers to provide those services is equally at risk of not being able to provide that service.
GEOFF HUTCHISON: So it's that still familiar, incomplete jigsaw isn't it.
STEVE HAMBLETON: Well it is. And I think that's where we've got to take a holistic approach to healthcare and particularly in areas like the Kimberley because it's - it is one health service for all the people up there. And in fact 80 per cent of the permanent population in the Kimberley are Aboriginal Australians, and that's the sort of thing we've got to understand, that we've got to focus on the permanent residents and make sure we look after everyone else as well.
GEOFF HUTCHISON: The federal government has announced that there are going to be 15 districts, nationwide, that will be the beneficiaries of mental health care centres - Bunbury, the City of Swan among them.
It's been called for for a long time. How important are they? What will they do?
STEVE HAMBLETON: Well some of - collecting services and providing workers in these areas is going to be absolutely critical. We know that the mental health needs of Indigenous Australia, Aboriginal Australia is very very high because of all sorts of reasons - the remoteness, the low socio-demographic, the poor levels of education and housing, all the other things.
So we need these mental health services.
The trouble is this comes on the back of the government about to cut rebates for GPs to provide mental health services, you know, and the budget we actually - we see that cutback. And we said we want you to invest in mental health, not take from one area - and put it in another.
We need both.
And I think that we welcome this new investment in mental health services. We need the infrastructure to be able to deliver that, but we need the GPs to be able to do their part as well, and we're just concerned that particularly in Aboriginal medical services, where their price is inelastic - they're not going to be able to charge their patients a fee to actually provide this service - income's going to go down. And that's a concern too.
GEOFF HUTCHISON: What about the ability - and this is often a big problem in Western Australia, we could take calls now from people who say, you know, our local doctor is 72, and he should have retired by now. We don't know who will replace him. We now drive three hours to get the kind of care that we used to take for granted. Where are we at when it comes to dealing with the, one, that doctor shortage in regional and remote places, and that's very true in Western Australia, but two, the ability to attract doctors to those environments. I know it's a - partly a governmental responsibility, it's a community responsibility.
Are we doing better at it?
STEVE HAMBLETON: Well we're starting to see increased numbers of doctors in rural areas which is actually a good thing, but the trouble at the moment is we're relying on our international colleagues to actually provide a lot of that work, and the - I guess the problem for our international colleagues is they weren't trained here. It's hard to actually assimilate to the Australian system. It doesn't matter whether you speak English as your first language or whether you don't.
These are well-trained individuals. But if you put me in a remote location in another country with, where it was my second language, I would have a lot of trouble, so they need a lot of support.
We are training more doctors. We've actually doubled our medical student numbers right across the country.
The challenge is to get those doctors properly trained, out into the community. And I think we're in that lull at the moment where we're bringing our numbers up.
Now the government has set up an organisation called Health Workforce Australia which is going to actually look at the numbers and where they're going to be and trying to make some realistic estimates of how many doctors we're actually going to need, and where we're going to train them.
That will inform us, and we're expecting the outcomes of that later this year. But we do need to teach and train, we do need to get our doctors out into the rural areas, and we need to make sure we have systems that can do that.
Now some of the things the government's trying to do is set up Super Clinics. Now the Super Clinics are putting a lot of money in a little, a small location - $650 million. And the AMA said if you spread that money around existing general practices around this country, you'd get a lot more leverage in terms of extra rooms for training, integration with allied health services, perhaps a better outcome than what we're seeing at the moment.
GEOFF HUTCHISON: Are we ever going to be able to reconcile the situation that yours is a lobby group, yours is the loudest and probably the most influential of medical lobby groups in this country; but there are so many conversations being had about, you know, where do you meet the areas of greatest need. And you have nursing practitioners who offer that option in so many environments.
And yet the AMA's still perceived to be saying, look - we're not against the idea. But the reality is you don't much like it. And then that perception is that you're trying to protect something that you've got.
How do we get kind of beyond that to get the best outcomes?
STEVE HAMBLETON: Well I think the way that medicine is moving forward, the way that medicine in Australia is moving forward is actually looking at working in teams. We certainly want to make sure that we're actually communicating with each other well, that appropriate skill sets are applied to health care, that people do work together.
One of our big concerns with the nurse practitioner, independent nurse practitioner push was fragmentation of service. We want to make sure that doctors and nurses work together. And when we talk to our patients that's what they want to see as well.
The health system, working as one health system to look after them.
And we believe that if we work in teams, and we're actually seeing general practices all across the country actually expanding in size, bringing in al health professionals, working much more closely with their local pharmacist, you know, we're getting the outcomes that we want to see.
The government's Super Clinic program actually leverages off that to some degree - this is not a new idea, it's happening already. Our concerns are when the government spends money it often does it in competition with local doctors instead of supporting them.
Now our health system is maturing. We've got more chronic disease to manage. But it's best done in a team environment.
And it is happening. And I think the value the AMA brings is to be able to connect the frontline, doctors delivering services with those trying to make policy, with government.
GEOFF HUTCHISON: Thanks for talking to us today.
STEVE HAMBLETON: Thank you very much.
GEOFF HUTCHISON: That's Steve Hambleton, who's the federal president of the AMA.
26 October 2011
CONTACT: John Flannery 02 6270 5477 / 0419 494 761
Follow the AMA Media on Twitter: http://twitter.com/ama_media
Follow the AMA President on Twitter: http://twitter.com/amapresident
